Provider Demographics
NPI:1770259426
Name:JENSEN, JESSICA LYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 GUNDERSEN DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2403
Mailing Address - Country:US
Mailing Address - Phone:630-871-2100
Mailing Address - Fax:
Practice Address - Street 1:336 GUNDERSEN DR STE A
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2403
Practice Address - Country:US
Practice Address - Phone:630-871-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34090103T00000X, 103T00000X
IL071.011101103T00000X
WAIVERED101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist